Transcript Slide 1

Teach to ALL Learners
Developmental Disabilities
Psychological Disabilities
Drug Detoxification
Contra Costa County Office of Education
California Department of Corrections
Defining Developmental
Disabilities
Life-long disabilities attributable to
mental and/or physical or
combination of mental and physical
impairments, manifested prior to
age twenty-two.
People with severe or multiple
disabilities may exhibit a wide range of
characteristics, depending on the
combination and severity of disabilities.
There are some traits they may share.
Can you guess what they would be?
?
If you guessed:
Limited speech or communication
Difficulty in basic physical mobility
Tendency to forget skills through
disuse
Trouble generalizing skills from one
situation to another
a need for support in major life
activities, e.g., domestic, leisure,
community use, self care.
You were absolutely correct!
Developmental Disabilities
is synonymous with
the use of the term
learning disability.
Cognitive disability is also used
synonymously in some jurisdictions.
Traumatic Brain Injury
Visual Impairments
Deaf and Hearing Loss
Cerebral Palsy
Mental Retardation
Down Syndrome
Emotional Disturbance
Autism or PDD (Pervasive Developmental Disorder)
Attention-Deficit/ Hyperactivity Disorder
Spina Bifida
Epilepsy
Learning Disabilities
Speech and Language Impairments
Developmental disabilities are
usually classified as severe,
profound, moderate or mild, as
assessed by the individual's need
for supports, which may be
lifelong.
Indicators of Developmental
Disabilities
Physical Appearance
Some Developmentally disabled
inmates/parolees have physical
handicaps in addition to their intellectual
and adaptive functioning deficits.
This is less common among those
functioning high enough to be
included in the CDCR population.
Speech
Developmentally disabled
inmates/parolees generally have
limited vocabulary and use simple
speech.
They may speak slowly and have or
have an articulation problem, e.g.
stuttering or slurred speech.
Developmentally Disabled Inmates may
avoid speaking, possibly to hide their
disability or to escape from potentially
embarrassing situation.
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Many of these inmates/ parolees may
have difficulty understanding what
others say and be reluctant to ask for
clarification.
Behavior
The most obvious maladaptive behaviors
displayed by developmentally disabled
inmates / parolees are in the area of:
•social skills
•safety skills
•activities of daily living (ADLs)
•some exhibit aggression toward others
Emotional Disturbance
a)An inability to learn that cannot be explained
by intellectual sensory, or health factors
b)An inability to build or maintain satisfactory
interpersonal relationships with peers and
teachers
c) Inappropriate types of behavior or feelings
under normal circumstances
d)A general pervasive mood of unhappiness or
depression
e)A tendency to develop physical symptoms or
fears associated with personal problems
Attention-Deficit / Hyperactivity
Disorder (AD/HD)… What is it?
It is a condition that can make it hard for a person
to sit still, control behavior and pay attention.
Doctors do not know just what causes AD/HD.
However, researchers who study the brain are
coming closer to understanding what may cause
AD/HD.
They believe that some people with AD/HD do not
have enough of certain chemicals (called
neurotransmitters) in their brain. These
chemicals help brain control behaviors.
How common is AD/ HD?
5 out of every 100 children in school may have
AD/HD.
Boys are three time more likely than girls to have
AD/HD.
What about Adults????
What is much less well known is the probability
that, of children who have AD/HD, many will still
have it as adults. Several studies done in recent
years estimate that between 30 percent and 70
percent of children with ADHD continue to exhibit
symptoms in the adult years.
What are the signs of AD/HD?
being very active (called hyperactivity)
problems with paying attention
acting before thinking
There are three types of AD/HD
based on the Diagnostic and Statistical Manual of Mental Disorders
(DSM)
1. Inattentive type, where
the person cannot seem
to get focused or stay
focused on a task or
activity
2. Hyperactive-impulsive
type, where the person is
very active and often acts
without thinking and
3. Combined type where the
person is inattentive,
impulsive and too active.
Inactivity Type of AD/HD
often:
Do not pay close attention to
details
Can’t stay focused on play or
school work
Can’t seem to organize tasks
and activities
Lose things
Hyperactivity-impulsive type
Being too active is probably the most
visible sign of AD/HD. This person is
always “on the go” (As he or she gets
older, the activity may go down).
They act before thinking (called
impulsivity).
They may be surprised to find
themselves in a dangerous situation.
They may have no idea of how to get out
of the situation.
Hyperactivity and impulsivity
tend to go together. They may:
Fidget and squirm
Get out of the chairs when they’re
not supposed to
Have trouble engaging in an activity
quietly
Interrupt others when they’re talking
and
Butt in on activities that others are
doing
To be effective, educational
programs need to incorporate a
variety of components to meet the
considerable needs of individuals
with severe and/ or multiple
disabilities.
Tips for Teachers
Figure out what specific things are hard for
the inmate/parolees. For example, one
inmate/parolee with AD/HD may have trouble
starting a task while another may have
trouble ending one task and staring the next.
Each inmate/parolee needs different help.
Post rules, schedules and assignments. Clear
rules and routines will help a inmate/parolee
with AD/HD. Have a set time for specific
tasks. Call attention to changes in the
schedule.
Teach study skills and learning strategies and
reinforce them regularly.
Help inmate/parolees channel his or her
physical activity (e.g., let the inmate/parolee
do some work standing up or at the board.
Provide regularly scheduled breaks.
Tips for Teachers, cont.
Make sure directions are given step by step
and that the inmate/parolee is following
directions. Give directions both verbally and
in writing. Many inmate/parolees with AD/HD
also benefit from doing the steps as separate
tasks.
Let the inmate/parolee do work on a
computer.
Regularly share with the inmate/parolee how
he or she is doing in class.
Have high expectations for the
inmate/parolee, but be willing to try new
ways of doing things. Be patient. Maximize
inmate/parolee’s chances for success.
Learning Disabilities (LD)
What are Learning Disabilities?
It is a general term that describes specific kinds of learning
problems. Learning disability can cause a person to have
trouble learning and using certain skills. The skills most often
affected are: reading, writing, listening, speaking, reasoning
and doing math.
LD vary from person to person. One person with LD may not
have the same learning problems as another person with LD.
Researchers think that LD are caused by differences in how a
person’s brain work and how it processes information. People
with LD are not “dumb” or ‘lazy.” In fact, they usually have
average or above average intelligence. Their brain process
information differently.
How Common are Learning
Disabilities?
Very common! As many as 1 out of every 5 people In the
United States has a LD. Almost 3 million children (age 6
through 21) have some sort of LD.
Adults? There is a growing body of reliable data that
indicate that learning disabilities (LD) in adults are a widespread problem. Until recently, we have only had estimates
of the incidence of adults with LD in specific segments of
the population including various formal and informal
educational and workplace training settings. Some
estimates have been alarmingly high. For example, the
United States Employment and Training Administration
(1991) estimated that between 15-23% of Job Training
Partnership Act (JTPA) title IIA recipients may have a LD.
Based on the Department of Labor observations, the
percent of adults with LD increases to between 50-80%
among those reading below the 7 th grade level.
Tips for Teachers
During a lecture, pause occasionally
allowing inmates/ parolees to take
the time to assimilate the
information and catch up with note
taking. Pauses can be used to erase
a board or change a video.
_____________________
When presenting abstract concepts,
support the concepts with concrete
examples or visual materials such
as charts and graphs.
Borderline Personality Disorder
BPD
A commonly used mnemonic to remember some features of BPD is
PRAISE:
P- Paranoid ideas
R- Relationship Disabilities
A- Angry Outburst
I- Impulsive Behavior, Identity disturbance
S- Suicidal Behavior
E- Emptiness
A diagnosis of BPD requires, according to the Diagnostic and
Statistical Manual of Mental Disorders (DSM), five or more of the
following to be present for a significant period of time:
Frantic efforts to avoid real or imagined abandonment. [Not
including suicidal or self-mutilating behavior covered in Criterion
5]
A pattern of unstable and intense interpersonal relationships
characterized by alternating between extremes of idealization and
devaluation.
Identity disturbance: markedly and persistently unstable self-image
or sense of self.
Impulsivity in at least two areas that are potentially self-damaging
(e.g., spending, promiscuous sex, eating disorders, substance
abuse, reckless driving, binge eating). [Again, not including
suicidal or self-mutilating behavior covered in Criterion 5]
Recurrent suicidal behavior, gestures, or threats, or self-mutilating
behavior.
Affective instability due to a marked reactivity of mood (e.g., intense
episodic dysphoria, irritability, or anxiety usually lasting a few
hours and only rarely more than a few days)
Chronic feelings of emptiness.
Inappropriate, intense anger or difficulty controlling anger (e.g.,
frequent displays of temper, constant anger, recurrent physical
fights). Transient, stress-related paranoid ideation or severe
dissociative symptoms.
DSM IV-Criterion 1 focus is on the frantic
efforts to avoid real or imagined
abandonment.
They are isolated, anxious and terrified at the thought of
being alone. If a person with BPD was neglected as a child or
raised in a severely dysfunctional household, they may have
learned to cope by denying or suppressing their terror at
being abandoned. After many years of practice, they no
longer feel their original emotion.
Several parolees confessed that being
incarcerated was actually an easier life
style. “When you are locked up, you don’t
have to worry about anything. You know
what you are going to eat, when you are
going to sleep and all that. Out here, there
are so many things to worry about… and
when you do try to make it out here in the
world, so many people judge you and don’t
give you a chance.” STAR
Parolees/Inmates Interview, 2007.)
The fear of abandonment is climaxed when
the BPD parolee is released from jail.
DSM IV-Criterion 2 focus is on a
pattern of interpersonal
relationships characterize by
alternating between extremes of
idealization and devaluation.
People with BPD look to others to provide
things that they find difficult to supply
for themselves, such as self-esteem,
approval and a sense of identity.
“It is no wonder that many find a sense of identity in
the gang culture or in imprisonment.”
Most of all, they are searching for a never-ending love and
compassion will fill the black hole of emptiness and despair
inside them. The intense neediness of people with BPD can
put a strain on any relationship. People with BPD often have
highly unstable patterns of social relationships. While they
can develop intense but stormy attachments, their attitudes
towards family, friends, and loved ones may suddenly shift
from idealization (great admiration and love) to devaluation
(intense anger and dislike). Thus, they may form an
immediate attachment and idealize the other person, but
when a slight separation or conflict occurs, they switch
unexpectedly to the other extreme and angrily accuse the
other person of not caring for them at all. Even with family
members, individuals with BPD are highly sensitive to
rejection, reacting with anger and distress to such mild
separations as a vacation, a business trip, or a sudden
change in plans. These fears of abandonment seem to be
related to difficulties feeling emotionally connected to
important persons when they are physically absent, leaving
the individual with BPD feeling lost and perhaps worthlessness.
DSM IV-Criterion 4 focuses on impulsivity and
self –damaging behavior (spending, sex,
substance abuse, reckless driving, binge
eating).
BPDs are aware of the long term consequence
of their behavior, but find it very difficult to
resist or control their impulses. If a person
feels empty and anxious most of the time,
pleasant activities are a welcome diversion.
Mood-altering drugs provide an even more
immediate relief and therefore can be a
powerful distraction. Harmful activities may be
a way of expressing rage or self-hate.
BPDs have no sense of “self.” They do
not know who they are; hence, they
try to fill the emptiness and create an
identify for themselves through
impulsive behaviors such as
indiscriminate sex activity, shoplifting,
compulsive drinking or substance
abuse. BPD and substance abuse goes
hand in hand. Recent statistics show
23% of BPDs had a diagnosis of
substance abuse. Borderline
substance abusers are likely to abuse
more than one drug (a frequent
combination is drug and alcohol
abuse.)
People with BPD are quite intuitive and have the
ability to read others very well. In the presence
of others, the person with BPD is able to fit in
much like a chameleon lizard by pretending to
blend in to their surroundings. Self-image is
based on the people around them. This allows
the person with BPD to feel in control and liked
by those present. The person with BPD tends to
go in whatever direction the wind is blowing.
There appears to be no depth of identity or
individuality to their own thinking. People with
BPD often have self-destructive behaviors that
may threaten their life or physical well-being. It’s
estimated that as many as 9% of all people with
BPD commit suicide.
DSM IV-Criterion 5 focuses on recurrent
suicidal behavior, gestures, or threats, or selfmutilating behavior.
Drug and alcohol abuse falls into this category of
dangerous and compulsive behavior. Another
common behavioral trait many is provoking physical
fights with others. Self-injury is a coping
mechanism that BPDs use to release manage
overwhelming emotional pain-usually feeling of
shame, anger, sadness or abandonment. Selfmutilation may release the body’s own opiates,
known as beta-endorphins.
These chemicals lead to a general feeling of wellbeing. People with BPD see themselves as in control
of these behaviors, which provides a false sense of
security.
Avoidance and denial is a sense of
security and protection. Projecting
blame, showing apathy and
remaining distance geographically
and emotionally are just some of
the ways people with drug
addiction and criminality cope
with obvious toxic problems. Many
would rather die alone in prison
than admit they are afraid,
confused and need help.
DSM IV-Criterion 6 focus is on the affective
instability due to a marked reactivity of
mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few
hours and only rarely more than a few days)
People with BPD may experience dramatic
mood swings from being very happy and
in control of their world, to suddenly
feeling very depressed, lonely, helpless,
and hopeless. In similar fashion, people
with BPD can move from a state of total
independence to one demanding lots of
attention.
It is reassuring to know that there is hope. Astonishingly
enough, researchers commonly believe that BPD results from a
combination that can involve individual genetic vulnerability and
environmental stress, neglect or abuse as young children, and
maturational events during adolescence or adulthood. Numerous
studies have shown a strong correlation between childhood
abuse and development of BPD. Many (but not all) individuals
with BPD report having had a history of abuse, neglect, or
separation as young children. Patients with BPD have been
found to be significantly more likely to report having been
verbally, emotionally, physically, and sexually abused by
caretakers of either gender. They were also much more likely to
report having caretakers (of both sexes) deny the validity of
their thoughts and feelings. They were also reported to have
failed to provide needed protection, and neglected their child's
physical care. Parents (of both sexes) were typically reported to
have withdrawn from the child emotionally, and to have treated
the child inconsistently. Additionally, female borderlines who
reported a previous history of neglect by a female caretaker and
abuse by a male caretaker were consequently at significantly
higher risk for being sexually abused by a non-caretaker (not a
parent).
Post Traumatic Stress Disorder (PTSD)
The traumas that cause PTSD are as unique as
the individuals suffering from the disorder. Any
fearful trauma can produce symptoms of PTSD. “I
remember being in a tornado a few years back,
and for the longest time, any wind, and I mean
any wind, would send tremors through my body.”
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PTSD can be either acute or chronic; the acute
phase occurring directly after the trauma, while
the chronic phase can come along much later. In
the acute phase, PTSD is said to be treatable and
curable. In its chronic phase, it is only treatable.
One must learn to live with it and to cope with it.
People with PTSD are famous
for self-medicating (drugs,
alcohol), and may have an
additional addiction that often
lands them in trouble, or jail:
an addiction to adrenaline. We
love danger, even when trying
to avoid it. Deep down inside,
we love adrenaline.
It has recently been learned that
prolonged stress actually changes a
person’s brain chemistry. PTSD is a
physical disease. There is no escaping it.
Even if most of the symptoms are
suppressed, a person with PTSD will
make all his/her decisions through the
veil of this disorder, simply because
one’s brain chemistry determines one’s
thought patterns.
PTSD: The Time Bomb
Inside every person with PTSD is a
time bomb. It is merely a matter of
time before symptoms begin to
show up. One might exhibit all
manner of symptoms in nearly
everything s/he does, and still live
what appears to be a normal life.
However, it doesn’t take much to
bring out full-blown symptoms of a
full-blown case of PTSD.
Keeping busy keeps the symptoms down. Free time (and
worry) exacerbates PTSD symptoms.
Additional Stress: Stress kills; we know this. Additional stress
in the life of a PTSD sufferer will bring out their PTSD
symptoms. Even good stress can increase one’s symptoms;
good stress such as a birth, or a new love, or a promotion at
work. Anything that wobbles the apple cart—little changes, big
changes, good changes, bad changes—will promote PTSD
symptoms. Then there are the huge stressors; the larger the
stressor, the more virulent the PTSD symptoms.
Reminders: anything that reminds the PTSD sufferer of the
original trauma will pique symptoms. This includes odors,
sounds, and sites. Additionally, the anniversary of a trauma will
cause a rise in PTSD symptoms. If a woman was assaulted near
an elevator, elevators will trigger her symptoms. If she
remembers the date of her assault, as the anniversary
approaches, symptoms increase.
PTSD &…
Anger
Flashbacks/Hallucinations
Fear
Dread
Hyper-Vigilance
Anxiety
Intimacy Issues
Intrusive Thoughts
Depression
Here are some more symptoms of PTSD
Drug and Alcohol Abuse
Addictions do come in handy sometimes: at least you have
to get out of bed for them.
Martin Amis
Avoidance/Immersion
Of all the…alternatives, running away is best.
Chinese Proverb.
Guilt
Guilt always hurries towards its complement, punishment;
only there does its satisfaction lie.
Lawrence Durrell
Memory Loss/Cognitive Dysfunction
The effectiveness of our memory banks is determined not by
the total number of facts we take in, but the number we
wish to reject.
Jon Wynne-Tyson
Teacher’s Tips for PTSD
•Teach Symptom Management, Anger
Management, and attending rap
groups (such as AA or NA) is a way of
keeping one’s symptoms at bay.
•Help inmates/ parolees know when
to reach out for help, is a second
strategy; one to fall back on when
the others don’t work.
•Practicing relaxation, meditation
have an enormous healing power for
the PTSD sufferer.
Anti Social Personality
Disorder (APD or ASPD)
This is a psychiatric diagnosis in
the DSM-IV-TR recognizable by
the disordered individual's
disregard for social rules and
norms, impulsive behavior, and
indifference to the rights and
feelings of others.
Diagnosis of antisocial personality disorder is
significantly more common among men than among
women Central to understanding individuals diagnosed
with antisocial personality disorder is that they appear
to experience a limited range of human emotions. This
can explain their lack of empathy for the suffering of
others, since they cannot experience the emotion
associated with either empathy or suffering. Riskseeking behavior and substance abuse may be
attempts to escape feeling empty or emotionally void.
The rage exhibited by psychopaths and the anxiety
associated with certain types of antisocial personality
disorder may represent the limit of emotion
experienced or there may be physiological responses
without analogy to emotion experienced by others.
Research has shown that individuals
with antisocial personality disorder
are indifferent to the possibility of
physical pain or many punishments
and show no indications that they
experience fear when so threatened.
This may explain their apparent
disregard for the consequences of
their actions and their
aforementioned lack of empathy.
Diagnostic criteria (DSM-IV-TR)
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV,
currently DSM-IV-TR), a widely used manual for diagnosing mental
and behavioral disorders, defines antisocial personality disorder as a
pervasive pattern of disregard for and violation of the rights of others
occurring since age 15, as indicated by three (or more) of the
following:
failure to conform to social norms with respect to lawful behaviors as
indicated by repeatedly performing acts that are grounds for arrest
deceitfulness, as indicated by repeated lying, use of aliases, or conning
others for personal profit or pleasure
impulsivity or failure to plan ahead
irritability and aggressiveness, as indicated by repeated physical fights or
assaults
reckless disregard for safety of self or others
consistent irresponsibility, as indicated by repeated failure to sustain
steady work or honor financial obligations
lack of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated, or stolen from another
Mnemonic
A mnemonic that can be used to
remember the criteria for antisocial
personality disorder is CORRUPT:
C - cannot follow law
O - obligations ignored
R - remorselessness
R - recklessness
U - underhandedness
P - planning deficit
T - temper
Teacher’s Tips
The most important goals of treating antisocial
behavior are effectively teach him or her the
positive behaviors that should be adopted instead.
Teachers need to be modeling and reinforcing
appropriate behaviors as well as in providing
appropriate discipline to prevent inappropriate
behavior.
A variety of methods may be employed to deliver
social skills training, but especially with diagnosed
anti-social disorders, the most effective methods are
systemic therapies which address communication
skills These probably work best because they entail
actually developing (or redeveloping) positive
relationships between ASPD and other people.
Teacher’s Tips, cont.
Methods used in social skills training include
modeling, role-playing, corrective feedback,
and token reinforcement systems.
Regardless of the method used, the level of
cognitive and emotional development often
determines the success of treatment.
A supportive, nurturing, and structured
classroom environment is believed to be the
best defense against anti-social behavioral
problems.
WHAT IS A DEPRESSIVE DISORDER?
A depressive disorder is an illness that involves
the body, mood, and thoughts. It affects the
way a person eats and sleeps, the way one
feels about oneself, and the way one thinks
about things. A depressive disorder is not the
same as a passing blue mood. It is not a sign
of personal weakness or a condition that can
be willed or wished away. People with a
depressive illness cannot merely "pull
themselves together" and get better. Without
treatment, symptoms can last for weeks,
months, or years. Appropriate treatment,
however, can help most people who suffer from
depression.
TYPES OF DEPRESSION
Depressive disorders come in
different forms, just as is the
case with other illnesses such as
heart disease. There are three
of the most common types of
depressive disorders. However,
within these types there are
variations in the number of
symptoms, their severity, and
persistence.
Major depression is manifested by a combination of symptoms (see
symptom list) that interfere with the ability to work, study, sleep, eat,
and enjoy once pleasurable activities. Such a disabling episode of
depression may occur only once but more commonly occurs several
times in a lifetime.
A less severe type of depression, dysthymia, involves long-term,
chronic symptoms that do not disable, but keep one from functioning
well or from feeling good. Many people with dysthymia also
experience major depressive episodes at some time in their lives.
Another type of depression is bipolar disorder, also called manicdepressive illness. Not nearly as prevalent as other forms of
depressive disorders, bipolar disorder is characterized by cycling
mood changes: severe highs (mania) and lows (depression).
Sometimes the mood switches are dramatic and rapid, but most often
they are gradual. When in the depressed cycle, an individual can have
any or all of the symptoms of a depressive disorder. When in the
manic cycle, the individual may be overactive, overtalkative, and have
a great deal of energy. Mania often affects thinking, judgment, and
social behavior in ways that cause serious problems and
embarrassment. For example, the individual in a manic phase may
feel elated, full of grand schemes that might range from unwise
business decisions to romantic sprees. Mania, left untreated, may
worsen to a psychotic state.
SYMPTOMS OF DEPRESSION AND
MANIA
Not everyone who is depressed or manic
experiences every symptom. Some people
experience a few symptoms, some many.
Severity of symptoms varies with
individuals and also varies over time.
Depressive disorders make one feel
exhausted, worthless, helpless, and
hopeless. Such negative thoughts and
feelings make some people feel like giving
up. It is important to realize that these
negative views are part of the depression
and typically do not accurately reflect the
actual circumstances. Negative thinking
fades as treatment begins to take effect.
Depression
Persistent sad, anxious, or "empty" mood
Feelings of hopelessness, pessimism
Feelings of guilt, worthlessness, helplessness
Loss of interest or pleasure in hobbies and activities
that were once enjoyed, including sex
Decreased energy, fatigue, being "slowed down"
Difficulty concentrating, remembering, making
decisions
Insomnia, early-morning awakening, or oversleeping
Appetite and/or weight loss or overeating and weight
gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to
treatment, such as headaches, digestive disorders,
and chronic pain
Mania
Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior
Help your parolees/ inmates:
•Set realistic goals in light of the depression and assume a
reasonable amount of responsibility.
•Break large tasks into small ones, set some priorities, and do what
you can as you can.
•Try to be with other people and to confide in someone; it is usually
better than being alone and secretive.
•Participate in activities that may make you feel better.
•Mild exercise, going to a movie, a ballgame, or participating in selfhelp meeting, clean and sober social, or other activities may help.
•Expect your mood to improve gradually, not immediately. Feeling
better takes time.
•It is advisable to postpone important decisions until the depression
has lifted. Before deciding to make a significant transition change
jobs, get married or divorced discuss it with others who know you
well and have a more objective view of your situation.
•People rarely "snap out of" a depression. But they can feel a little
better day-by-day.
•Remember, positive thinking will replace the negative thinking that
is part of the depression and will disappear as your depression
responds to treatment.
•Let your family and friends help you.
Treating Depression
The good news about recognizing and understanding depression
early is that it can be treated. Antidepressant medications are widely
used, effective treatments for depression. Antidepressant drugs are
known to influence the functioning of certain neurotransmitters
(chemicals used by brain cells to communicate), primarily serotonin,
norepinephrine, and dopamine.
Psychotherapy is also effective for treating depression. Certain types
of psychotherapy, cognitive-behavioral therapy (CBT) and
interpersonal therapy (IPT), have been shown to be particularly
useful. More than 80 percent of people with depression improve
when they receive appropriate treatment with medication,
psychotherapy, or the combination.
Drug Detoxification (Post Acute Withdrawal)
Post Acute Withdrawal Syndrome
Post Acute Withdrawal is an adjustment the
brain has to make while in the process of
returning to life without chemicals. It is the
time period when neurotransmitters start acting
again.
During periods of addiction to drugs, alcohol
and/or other substances of abuse there is
artificial stimulation and disruption to normal
brain function. During the adjustment period
difficulty in thinking clearing, expressing
emotions, memory, coordination, sleep
disturbances and stress are all common.
What is Post Acute Withdrawal syndrome?
(PAW)
In this section symptoms are identified, and a portion of the
process which may be required during addiction treatment are
outlined.
The process of dealing with post acute withdrawal syndrome
differs from person to person, making it critical to enlist
professional help.
The guidelines presented to aid in overcoming frustrations and
bring back a normal balance to the brain and life in general are
similar to those adhered to by drug rehab centers.
The most common symptoms of Post Acute Withdrawal when
overcoming addiction are:
Unclear thinking.
Difficult emotions.
Difficult physical coordination.
Sleep disturbances.
Stress.
Help for Overcoming Alcohol and Drug Addiction Post
Acute Withdrawal Syndrome
Listing Strengths and Weaknesses in the Above Areas May
also be Required:
Example:
Strength: Plays basketball for fun.
Weakness: Runs into objects or appear off balance at times.
Setting a Plan for Overcoming Areas of Weakness, is
Usually Encouraged:
When thinking is unclear breaking tasks into portions may be
recommended.
(EG: Read a part of a book, or directions at a time, take a break
and return at a later time.)
Journaling feelings to remain calm when issues are discussed
may be recommended.
If a period of depression becomes apparent, watching a funny
video or taking time to ‘play’ may be encouraged.
Walking a dog or taking a child to a park to assist in re-engaging
in life could be suggested.
Other suggestions may include:
Making a lists, including ‘daily priorities’ or ‘shopping lists’ to
remove frustration.
Staring uncompleted tasks on the following day.
Being cautious of ‘simulative substances’ (caffeine, sugars,
etc.) prior to sleep.
Reading a book which might assist in relaxation prior to sleep.
* Taking more frequent ‘breaks’ during the day, even if ‘resting’
in a car while repeating positive affirmations, are encouraged
on occasion.
Further recommendations may allow for:
Keeping expectations reasonable, to avoid ‘over-stressing’.
Sobriety, followed by support group attendance similar to AA,
other sober activities, and/or church group attendance.
Eat three regular meals a day with ‘snacking’ between.
Vitamins to help regain lost nutrition.
Meditation and/or other similar relaxation techniques.
Symptoms of Post Acute Withdrawal May Contain:
Lack of confidence.
Denial. (Examples of ‘denial’ thoughts: ‘It wasn't really that
bad’, or ‘I can handle it now’.)
Lack of commitment to a support system.
Trying to change others before they are ready.
Defensiveness.
Compulsive behavior. (Becoming compulsive or out of
balance in other areas of life.)
Impulsive behavior. (Acting before thinking, or sudden
outbursts.)
Daydreaming.
Depression.
Easily Angered.
Irregular sleep.
A ‘don't care,’ attitude.
Feeling hopeless.
Self pity.
Conscious lying.
Loneliness.
Controlled drinking. (Attempting to limit or control use.)
Loss of control. (Returning to the original state of
consumption (relapse).)
Change often begins within post acute withdrawal syndrome.
Watch for internal changes, which may carry:
Increased stress.
‘Why bother?’ emotions and thoughts.
Change in feelings; mood swings.
Change in behavior.
Putting on a facade. (Look good on the outside but feel terrible inside.)
Ideas which may be suggested for triumphing over post acute
withdrawal syndrome:
Look for balance living.
Limiting work to 40 hours per week.
Maintaining family relationships.
Continuing a spiritual connection.
Education or new learning. (Mental stimulation.)
Personal time.
Plans for calmness, sobriety and relapse prevention may entail:
1.) Say the serenity prayer.
God grant me the serenity to accept the things I cannot change.
Courage to change the things I can, and the wisdom to know the
difference.
2.) Call a counselor.
3.) Call sober friends.
4.) Jog around the block a few times.
5.) Eat regularly.
6.) Prayer.
‘Stinking Thinking ’ in Post Acute Withdrawal.
Examples:
I don't listen at AA and pass when it is my turn.
I get exhausted.
I don't like eating regularly.
I have high expectations.
I think the dangers of drugs are overreacted too.
I get tired of this Higher Power stuff.
The Map to Relapse in Post Acute Withdrawal:
Denial.
Resentment.
‘I don't care,’ attitude, no confidence.
Drop sponsor.
Blaming others.
Lie on purpose.
Don't ask for help.
Eat and sleep irregularly.
Associate with chemically abusing people.
Begin to relapse.
Don't expect your desire to consume to go away quickly.
Using Thoughts to Help Overcome Urges Might Include:
‘I can wait till tomorrow.’
Remembering some of the pain drugs, alcohol or substances have
caused.
Thinking of the good attributes of sobriety.
You Can Be a Great Teacher for Inmates /
Parolees with:
Psychological
Disorders
Developmental
Disabilities
Drug
Detoxification
“Create a bridge between curriculum and
Parolees/Inmates-all kinds of Parolees/Inmates
with all kinds of minds.”
A great teacher UNDERSTANDS the relationship between
emotion and cognition. The great teacher does not assume
that the learning difficulties are the consequence of bad
behavior, acting out or refusal on the Parolees/Inmate’s part to
comply.
Rather, the teacher understands that these are coping
mechanisms triggered by the stress generated by frustration
and fear of what many see as an inevitable failure.
The great teacher does not use this understanding to excuse
the behavior, but to work through it or around it. The great
teacher knows that may of these negative emotions and
troubling behaviors go way when Parolees/Inmates feel
competent and successful.
A great teachers KNOWS that Parolees/Inmates
learn in different ways, but does not trivialize this.
A great teacher FOCUSES on the learner first and
the curriculum second. Her takes the
Parolees/Inmates ot a place of cognitive and
psychological safety before venturing into deeper
waters of new material. This teacher understands
the importance of creating a positive connection to
prior learning, or tapping into a Parolees/Inmates’s
positive emotions about a task or a topic, and
helping Parolees/Inmates recognize and reduce
negative influences on learning (e.g., automatically
saying or thinking: I can’t DO math!”). By
practicing thought-stopping techniques and
generating positive self-statements that are tied to
A great teacher DEMONSTRATES
the ability to expose
Parolees/Inmates to a variety of
stimuli and knows when
Parolees/Inmates are connected
emotionally and cognitively to
the experience. He also gives
Parolees/Inmates the
opportunity to demonstrate
what they have learned ion a
variety of ways, and publicly
values these alternative ways to
display knowledge and skills.
A great teacher is GUIDED AND
ENERGIZED by finding out what
facilitates effective learning and what
gets in the way. The focus of teacher
is to minimize the impediments of
educating the learner about his or her
own cognitive style, modifying the
curriculum without lowering standards
and creating a learning space in which
Parolees/Inmates can feel safe and
competent.
A great teacher PRAISES THE PROCESS that
Parolees/Inmates use as often or more than
the product, since the product may be substandard (in the Parolees/Inmates' eyes or in
reality) even if the process is right. When a
great teacher gets a blank stare in response
to a question, they offer alternative choices.
This can generate an “Oh yeah” response;
the next time a question is asked, the
Parolees/Inmates is more likely to come up
with an answer that addresses how s/he
figured something out. That is the behavior
of a successful learner.
A great teacher UNDERSTANDS that it’s not about
having Parolees/Inmates work harder, but rather that
they work smarter. Great teachers Parolees/Inmates
what strategies they have used in the past to be
successful in any kind of learner (in school or outside
of school) and helps to translate that skill and recreate
the positive learning experience in the classroom. We
all know the Parolees/Inmates who can take apart and
rebuild a computer but can’t read. The great teacher
focuses on how the Parolees/Inmates learned to do the
former an uses the knowledge as a basis for
specialized instruction in reading. If a child says, “I
remember everything I see” ought to be able to
capitalize on the strength by developing a sight word
vocabulary that will jumpstart more difficult reading.
A great teacher is WILLING to take a risk when it
comes for advocating for a Parolees/Inmates/ parolee.
“This Parolees/Inmates will not be successful without
some significant supports—more than I am able to
give in this classroom even though I’m awesome.”
A great teacher EXAMINES his classroom practices to
identify what works and what doesn’t. These teachers
are more likely than other teachers to want to work
with another adult, ask for feedback about
performance, go to professional conferences and inservices with the needs of individual Parolees/Inmates
in their heads, and be willing and able to teach others
what they know.
A great teachers knows how to work as a team
with Parolees/Inmates as a key member.
Building and maintain relationships with the
POC, social workers, parole agents, correctional
officers takes time and sincere effort. Reaching
out to psychiatrist and psychiatric technicians
to get and give information if medication or
health issues are involved is an important skill.
Working with ancillary personnel in CCCOE/
CDCR and helping them help you as a teacher
incorporate therapeutic interventions in the
classroom is critically important.
A great teacher UNDERSTAND that
cultural and language factors play an
important role in learning. Great
teachers are able to read subtle but
important behaviors such as eye contact
or physical proximity, and accurately
interpret them in the social /cultural
context of the parolee/ inmate.
Communication and
Interaction
“The goal of effective
communicating is to understand
and to be understood.
Communication may occur
verbally, non-verbally, and/ or in
written form.”
Active Listening
Non-verbal communication is defined as an
exchange of information, without speaking,
through the use of gestures, body language
or facial expression. Non-verbal
communication is generally used in
conjunction with verbal. The ‘unspoken”
message can alter the meaning of the
communication. Be aware that there is
considerable danger of misinterpretation of
the non-verbal component of the message,
especially if it is not consistent with the verbal
message.
Non-Verbal Active Listening
Body Language: Leaning forward, facing the speaker
and maintain an open posture may indicate tto the
speaker that you are paying attention.
Facial expression: Smiling, looking interested an
making eye contact may communicate interest to the
person.
Gestures: Head nods and open hand gestures provide
non-verbal encouragement that says, “Go on please.”
Verbal communication is the exchange
of information through the use of the
spoken word. The volume, inflection
and tone of voice may alter the
meaning.
“Stop
shouting! I
can’t hear
what you are
saying!”
13 Verbal aspects of active listening:
1.Verbal Encouragers: Small brief words or phrases
that encourage the inmate/parolee to continue
talking, e.g., “Uh-huh,” Really,” “Hmmm,” “You’re
kidding!”
2.Clarification: Helps the inmate/parolee express
unclear feelings, ideas and perceptions. This
process can be used to point out inconsistencies
between an inmate’s word and actions, e.g., “ You
said you are not sad, but you have tears welling up
in your eyes.”
3.Restating: Repeating the main thought or idea the
inmate has expressed, also called paraphrasing,
e.g., “You say you decided not to go inot the
room?”
4. Open-ended Questions: When possible, avoid questions
which can be answered “yes” or “no.” Ask open-ended
questions such as who what when and how questions.
5. Focusing; Make statements or ask questions that help
focus the inmate on the main issue, e.g., “You have lots of
complaints but he main one seem to be problems with your
cell mate. Please tell me more about that.”
6.Avoid “Why” Questions. Questions beginning with “why”
tend to make the inmate defensive. Try rephrasing an ‘why
question” by stating it as a personal statement or “I’
message, e.g., don’t say “Why did you refuse to come out of
your cell? “ Instead try, “I thought you enjoyed school and
now you are refusing to go. What changed? “ [or] “When did
you start feeling differently?”
Now, let’s
practice!!!!